Healthcare Provider Details

I. General information

NPI: 1023923539
Provider Name (Legal Business Name): JORDAN VALENZUELA CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1563
US

IV. Provider business mailing address

4569 GOODE ST
ANTIOCH CA
94531-7194
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-2126
  • Fax:
Mailing address:
  • Phone: 415-702-7183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95105579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: